Metformin-associated lactic acidosis presenting as an ischemic gut in a patient who then survived a cardiac arrest: a case report

Journal of Medical Case Reports

Krishnaswamy Sundararajan²  Rhea Mae R Sicat¹  Dumisani Ncomanzi¹ 

[1] Intensive care unit, Critical care services, Level 4, Robert Gerard Wing, Royal Adelaide Hospital, North terrace, Adelaide, SA 5000, Australia;Senior Clinical Lecturer, Discipline of Acute care Medicine, University of Adelaide, Adelaide, SA 5000, Australia

关键词: Metformin;    Lactic acidosis;    Ischemia;    Gut;    Cardiac arrest;   

Others  :  820868
DOI  :  10.1186/1752-1947-8-159

 received in 2014-01-06, accepted in 2014-04-28,  发布年份 2014

【 摘 要 】

Introduction

Lactic acidosis is the most common cause of metabolic acidosis in hospitalized patients. It is recognized as a potential complication of metformin use, particularly in patients with risk factors such as renal dysfunction, liver disease, and heavy alcohol ingestion. These conditions are associated with systemic hypoxemia, which may be caused by cardiorespiratory disease, major surgery, sepsis, dehydration, old age, and overdose. The reported frequency of lactic acidosis is 0.06 per 1000 patient-years, mostly in patients with predisposing factors. This case is important because it details the seriousness of metformin-associated lactic acidosis in a critically ill patient and because, to the best of our knowledge, our patient survived with minimal residual defect despite experiencing a cardiac arrest.

Case presentation

A 66-year-old Caucasian woman presented to our hospital with profound lactic acidosis, which was initially thought to be ischemic gut. She then survived an in-hospital pulseless electrical activity arrest.

Conclusion

Metformin-associated lactic acidosis is a diagnosis by exclusion; however, a high degree of clinical suspicion supplemented by prompt multisystem organ support can significantly influence the outcome in critically ill patients.

【 授权许可】

   
2014 Ncomanzi et al.; licensee BioMed Central Ltd.

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